Menstruators are defined as any person, regardless of gender, who menstruates/has periods. To be clear, menstruating does not mean someone is a woman and being a woman does not mean the person menstruates (or ovulates). All menstruators can experience premenstrual syndrome (PMS).
In this post, we will go over some of the common strategies to manage your PMS. This FAQ is broken up into three main sub-sections
To learn more about the causes of PMS, read our FAQ here.
What is PMS?
PMS is a cyclical condition with symptoms arising during the luteal phase (after ovulation) and ceasing within the first couple of days after menstruation. The cyclical pattern of symptoms is what defines PMS and rules out different mental or physical health diagnoses. In their lifetime, 90-95% of menstruators who are in the reproductive age range experience PMS, with 3-8% experiencing symptoms so severe that the symptoms negatively impact the quality of their daily life (this is diagnosed as Premenstrual Dysphoric Disorder - PMDD) (*1-*6).
PMS can be confusing because it encompasses such a diverse range of physical, emotional and behavioural symptoms that are unique to individuals, with no definitive lab tests for diagnosis (1-8). These symptoms include, but are not limited to:
Severe headaches and migraines
Severe and intense mood fluctuations
Tracking your menstrual cycle
If you do experience cyclical discomfort associated with your MC, daily menstrual tracking over two to three cycles is highly recommended (*4, *7). When we chart ‘retrospectively’ or after the fact - this is how a lot of MC data is collected in research - we can easily forget or minimize symptoms and experiences which reduces the accuracy of our report. Many people often have difficulty remembering what they ate yesterday, not to mention how their mood was 2 weeks ago.
Tracking creates increased bodily awareness and helps healthcare providers give an accurate diagnosis of symptoms. The more information you are able to provide, the easier it can be to identify patterns in symptoms and create a targeted approach.
There are a variety of menstrual tracking resources and apps where you can record a large scope of data (cervical fluid, menstruation, multiple symptoms, sleep, mood, activity, stress, social support, sexual activity, etc.). The more information you have over multiple months, the easier it will be for your healthcare provider to help you find relief. Tracking allows you to advocate for your health, promotes a deeper connection to the physical body and mind, and illustrates important changes over the MC.
Some Apps I would recommend (I have personally tried all of them and like them for different reasons):
30-day free trial. After that, it is $2.50/month.
This is my favourite - most customizable and user-friendly.
Free version available.
(Clue+) 7-day free trial (if you sign up for an annual subscription). Moving forward, it is $3.33/month.
Best aesthetic and also user-friendly.
I don’t have a Fitbit device anymore, but I still use this app for tracking my MC.
Very user-friendly and SIMPLE.
Another method of tracking is the simple pen and paper method. Here and here are links to free, printable monthly trackers that I’ve used myself and would highly recommend. These are especially helpful if you don’t have access to the apps and/or prefer to write yourself. With pen and paper, it’s also easy to further customize.
Treating your PMS
Due to the multifactorial nature of PMS, there are a wide variety of treatment options. Pharmacotherapy is currently the primary route of PMS symptom treatment in the Western healthcare system. This includes various medications such as selective serotonin reuptake inhibitors (SSRIs) and oral contraceptives (8, 9). Importantly, these treatment options can only be prescribed by a healthcare professional. More recent research suggests that combination therapy, that is medication in addition to non-pharmacological solutions such as talk therapy (typically cognitive behavioural therapy), dietary and nutritional changes, exercise, and massage, can be successful in those who experience regular PMS (8, 10).
For those who experience intense depressive symptoms leading up to menstruation, SSRIs are commonly prescribed for effective symptom relief within weeks (*11-14). SSRIs may not be the right choice for everyone and it is important that you consult with your primary care doctor to determine the best course of action for you.
Studies have also shown that reducing the fluctuation of reproductive hormones with medication (i.e. hormonal birth control) and ovarian suppression (removal of ovaries or medication to prevent the release of hormones) leads to relief from PMS symptoms (*4, *12, *15, *16). To be clear, the removal of ovaries (also called an oophorectomy) is only performed as an absolute last option and is rarely necessary.
Vitamin and mineral supplements are an accessible first course of action when pursuing relief from PMS symptoms (*17). Especially if you are unsure about pharmacological interventions, inquiring about vitamin and mineral levels and options is a great first step. It is important to talk to a trusted healthcare professional before taking any medications or supplements to treat your PMS, even those that are available without a prescription!
For example, Vitamin D supplementation has recently been suggested as a promising non-pharmacological PMS intervention. However, the scientific studies that show a positive effect of Vitamin D on PMS symptoms had participants taking extremely large doses that are far above the daily recommended intake suggested for ‘general health’ (18, 19). This type of dosing is done for a short period of time (2-3 months) because we cannot take these high amounts indefinitely. The purpose is to quickly raise Vitamin D levels and improve any deficiencies that an individual may have; however, even menstruators without Vitamin D deficiency saw symptom relief (18, 19). Conversely, studies that had participants take a typical daily dose of vitamin D showed no change in PMS symptoms (18, 19). Importantly, you should not attempt to take such large doses of vitamin D on your own. If you are interested in this type of intervention, talk to your healthcare provider!
Other vitamins and minerals that have been shown to provide relief to some menstruators include magnesium (Mg) and calcium (Ca) paired with vitamin D (*17, 20, 21). For example, Mg helps to normalize both estrogen and progesterone effects, as well as promoting muscle relaxation (particularly related to cramps and headaches), increased sleep quality, and influences the parasympathetic nervous system (‘rest and digest’ system) (*7, *12,*17, *20, *21).
Regardless of your path for PMS symptom relief, it is important to speak to a trusted healthcare professional about your individual symptoms and experiences to decide the best course for treatment and relief. A great place to start with your doctor is to discuss recent symptoms you’ve experienced and ask questions about the solutions you are interested in. Having your healthcare provider help monitor, interpret and understand any further symptoms or side effects is the best way to find PMS symptom relief.
If you have any feedback on this post or any of the content created by missINFORMED, please reach out to us at email@example.com. We appreciate and welcome all feedback as we are committed to the continuous growth and improvement of our organization.
*These sources do not specify the gender identity of the women included. Historical representation leads us to believe that only cisgender women were included.
Biggs WS, Demuth RH. Premenstrual syndrome and premenstrual dysphoric disorder. Am Fam Physician. 2011 Oct 15;84(8):918-24. Available from: https://www.aafp.org/afp/2011/1015/p918.html [Accessed 6th December 2020].
Harlow S, Ephross S. Epidemiology of Menstruation and Its Relevance to Women's Health. Epidemiologic Reviews. 1995;17(2):265-286. Available from: doi: 10.1093/oxfordjournals.epirev.a036193
Kwan I, Onwude JL. Premenstrual syndrome. BMJ Clin Evid. 2015 Aug. 2015;0806.
Cruz JDJ, Cruz FES. Premenstrual syndrome - a short review. Obstet Gynecol Int J. 2016;5(4): 00164. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4548199/ [Accessed 6th December 2020].
Eisenlohr-Moul T. Premenstrual Disorders: A Primer and Research Agenda for Psychologists. Clin Psychol. 2019 Winter;72(1):5-17. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7193982/ [Accessed 6th December 2020].
Matsumoto T, Ushiroyama T, Kimura T, Hayashi T, Moritani T. Altered autonomic nervous system activity as a potential etiological factor of premenstrual syndrome and premenstrual dysphoric disorder. Biopsychosoc Med. 2007 Dec 20;1:24. Available from: doi: 10.1186/1751-0759-1-24
Walsh S, Ismaili E, Naheed B, O’Brien S. Diagnosis, pathophysiology and management of premenstrual syndrome. The Obstetrician & Gynecologist. 2015;17:99-104. Available from: doi: https://doi.org/10.1111/tog.12180
Ryu, A., & Kim, T. H. (2015). Premenstrual syndrome: A mini review. Maturitas, 82(4), 436–440. https://doi.org/10.1016/j.maturitas.2015.08.010
Marjoribanks, J., Brown, J., O'Brien, P. M., & Wyatt, K. (2013). Selective serotonin reuptake inhibitors for premenstrual syndrome. The Cochrane database of systematic reviews, 2013(6), CD001396. https://doi.org/10.1002/14651858.CD001396.pub3
Lustyk, M. K., Gerrish, W. G., Shaver, S., & Keys, S. L. (2009). Cognitive-behavioral therapy for premenstrual syndrome and premenstrual dysphoric disorder: a systematic review. Archives of women's mental health, 12(2), 85–96. https://doi.org/10.1007/s00737-009-0052-y
Usman SB, Indusekhar R, O'Brien S. Hormonal management of premenstrual syndrome. Best Pract Res Clin Obstet Gynaecol. 2008 Apr;22(2):251-60. Available from: doi: 10.1016/j.bpobgyn.2007.07.001.
Rapkin AJ, Akopians AL. Pathophysiology of premenstrual syndrome and premenstrual dysphoric disorder. 2012;18:52-59. Available from: doi: 10.1258/mi.2012.012014.
Freeman EW. Treatment of depression associated with the menstrual cycle: premenstrual dysphoria, postpartum depression, and perimenopause. Dialogues in Clinical Neuroscience. 2002;4(2):177-191. Available from: doi: 10.31887/DCNS.2002.4.2/efreeman
Shah NR, Jones JB, Aperi J, Shemtov R, Karne A, Borenstein J. Selective serotonin reuptake inhibitors for premenstrual syndrome and premenstrual dysphoric disorder: a meta-analysis. Obstet Gynecol. 2008 May;111(5):1175-82. Available from: doi: 10.1097/AOG.0b013e31816fd73b
Schmidt PJ, Nieman LK, Danaceau MA, Adams LF, Rubinow DR. Differential behavioral effects of gonadal steroids in women with and in those without premenstrual syndrome. N Engl J Med. 1998 Jan 22;338(4):209-16. Available from: doi: 10.1056/NEJM199801223380401.
Yonkers KA, O'Brien PM, Eriksson E. Premenstrual syndrome. Lancet. 2008 Apr 5;371(9619):1200-10. Available from: doi: 10.1016/S0140-6736(08)60527-9
Parazzini F, Di Martino M, Pellegrino P. Magnesium in the gynecological practice: a literature review. Magnesium Research. 2017;30(1):1-7. Available from: doi: 10.1684/mrh.2017.0419.
Arab, A., Golpour-Hamedani, S., & Rafie, N. (2019). The Association Between Vitamin D and Premenstrual Syndrome: A Systematic Review and Meta-Analysis of Current Literature. Journal of the American College of Nutrition, 38(7), 648–656.
Bertone-Johnson, E. R., Hankinson, S. E., Bendich, A., Johnson, S. R., Willett, W. C., & Manson, J. E. (2005). Calcium and vitamin D intake and risk of incident premenstrual syndrome. Archives of internal medicine, 165(11), 1246–1252. https://doi.org/10.1001/archinte.165.11.1246
Abdi F, Ozgoli G, Rahnemaie FS. A systematic review of the role of vitamin D and calcium in premenstrual syndrome. Obstet Gynecol Sci. 2019 Mar;62(2):73-86. Epub 2019 Feb 25. Erratum in: Obstet Gynecol Sci. 2020 Mar;63(2):213. Available from: doi: 10.5468/ogs.2019.62.2.73
Fathizadeh N, Ebrahimi E, Valiani M, Tavakoli N, Yar MH. Evaluating the effect of magnesium and magnesium plus vitamin B6 supplement on the severity of premenstrual syndrome. Iran J Nurs Midwifery Res. 2010 Dec;15(Suppl 1):401-5. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3208934/ [Accessed 5th January 2021]
Walsh S, Ismaili E, Naheed B, O’Brien S. Diagnosis, pathophysiology and management of premenstrual syndrome. The Obstetrician & Gynecologist. 2015;17:99-104. Available from: doi:https://doi.org/10.1111/tog.12180